U.S. patent application number 10/376022 was filed with the patent office on 2004-06-10 for system and a method for providing integrated access management for peritoneal dialysis and hemodialysis.
Invention is credited to Coman, Like, DeLaCruz, Rich, Firanek, Catherine, Marritt, Richard, McNally, Larry, Mujais, Salim, Vecsey, Andy.
Application Number | 20040111294 10/376022 |
Document ID | / |
Family ID | 32511025 |
Filed Date | 2004-06-10 |
United States Patent
Application |
20040111294 |
Kind Code |
A1 |
McNally, Larry ; et
al. |
June 10, 2004 |
System and a method for providing integrated access management for
peritoneal dialysis and hemodialysis
Abstract
A system and a method for tracking patients having renal
disease, particularly Chronic Kidney Disease (CKD), are provided.
The system and method track patients through a common system with
multiple healthcare professionals, such as doctors, nurses and the
like, having access to the system and updating the system based on
information regarding the care, treatment, diagnosis, therapy, or
the like provided to the patients. The system and method interface
with remote machines and supply chains by a modem, via the internet
or by wireless devices. The system and method provide a continuum
of care for renal patients, i.e., CKD, peritoneal dialysis (PD),
home hemodialyis (HHD), in-center hemodialysis and transplant
within a single database associated with the system. The system and
method track the access information of PD patients and/or HD
patients. Specifically, the system and method track access
placement, infections, non-infection related problems, medications
and hospitalizations. The system and method may track PD and HD
information in one comprehensive module.
Inventors: |
McNally, Larry; (Mundelein,
IL) ; Vecsey, Andy; (Tampa, FL) ; DeLaCruz,
Rich; (Largo, FL) ; Mujais, Salim;
(Northbrook, IL) ; Coman, Like; (Chicago, IL)
; Marritt, Richard; (Deerfield, IL) ; Firanek,
Catherine; (Villa Park, IL) |
Correspondence
Address: |
PATENTS+TMS
A Professional Corporation
1914 North Milwaukee Avenue
Chicago
IL
60647
US
|
Family ID: |
32511025 |
Appl. No.: |
10/376022 |
Filed: |
February 28, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
10376022 |
Feb 28, 2003 |
|
|
|
10315435 |
Dec 9, 2002 |
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Current U.S.
Class: |
705/2 |
Current CPC
Class: |
G16H 10/60 20180101;
G16H 40/20 20180101; G16H 20/10 20180101; G16H 20/40 20180101; G06Q
40/08 20130101; G16H 40/67 20180101; G16H 80/00 20180101 |
Class at
Publication: |
705/002 |
International
Class: |
G06F 017/60 |
Claims
We claim:
1. A system to track and manage information regarding a patient
undergoing a plurality of therapies therapy for a disease, the
system comprising: an input means for receiving the information
regarding the patient and the plurality of therapies wherein the
patient receives at least one of the plurality of therapies to
treat the disease wherein the information is tracked and managed
for the patient for each of the plurality of therapies; means for
displaying the information related to each of the plurality of
therapies relating to the disease of the patient.
2. The system of claim 1 wherein one of the plurality of therapies
relates to peritoneal dialysis.
3. The system of claim 1 wherein one of the plurality of therapies
relates to hemodialysis.
4. The system of claim 1 wherein the information is input by a
healthcare professional.
5. The system of claim 1 wherein the information is input by the
patient.
6. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes data
relating to treatment of the patient.
7. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes data
relating to a problem associated with the patient.
8. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes data
relating to hospital admission of the patient.
9. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes data
relating to an implant detail of the patient.
10. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes data
relating to a clinical assessment of the patient.
11. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes data
relating to a dynamic assessment of the patient.
12. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes data
relating to an infection of the patient.
13. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes data
relating to a medication for the patient.
14. The system of claim 1 further comprising: a screen associated
with the display means wherein the information displayed includes
data relating to planning dialysis care for the patient.
15. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes a
compliance factor.
16. The system of claim 1 wherein the disease is renal disease.
17. The system of claim 1 wherein the therapy corresponds to at
least one of chronic kidney disease, peritoneal dialysis,
hemodialysis and transplant.
18. The system of claim 1 further comprising: a screen associated
with the display means wherein the information includes a history
of medications for the patient.
19. The system of claim 1 further comprising: a screen associated
with the display means wherein the screen includes a treatment
summary for the patient receiving one of the plurality of therapies
for the disease.
20. The system of claim 1 further comprising: a screen associated
with the display means wherein the screen includes a treatment
summary for the patient receiving one of the plurality of therapies
for the disease wherein the treatment summary includes a history of
treatment for the patient.
21. The system of claim 1 further comprising: a screen associated
with the display means wherein the screen includes a treatment
summary for the patient receiving one of the plurality of therapies
for the disease wherein the treatment summary includes a history of
infections for the patient.
22. The system of claim 1 further comprising: a screen associated
with the display means wherein the screen includes a treatment
summary for the patient receiving one of the plurality of therapies
for the disease wherein the treatment summary includes access
information for the patient.
23. The system of claim 1 further comprising: a screen associated
with the display means wherein the screen includes a treatment
summary for the patient receiving one of the plurality of therapies
for the disease wherein the treatment summary includes information
relating to a center at which the patient receives one of the
plurality of therapies for the disease.
24. The system of claim 1 further comprising: a screen associated
with the display means wherein the screen includes a treatment
summary for the patient receiving one of the plurality of therapies
for the disease wherein the treatment summary includes a
hospitalization summary for the patient receiving one of the
plurality of therapies for the disease.
25. The system of claim 1 wherein the input means for receiving the
information is retrievable on a plurality of display screens.
26. The system of claim 1 further comprising: an access tab screen
on the means for displaying wherein the access tab screen displays
a summary of implant details for the patient.
27. The system of claim 1 further comprising: an access tab screen
on the means for displaying wherein the access tab screen displays
a summary of clinical assessments for the patient.
28. The system of claim 1 further comprising: an access tab screen
on the means for displaying wherein the access tab screen displays
a summary of dynamic assessments for the patient.
29. The system of claim 1 further comprising: a chronic kidney
disease planning pathway for the patient.
30. The system of claim 1 further comprising: a screen associated
with the means for displaying wherein the screen includes
information to order prescriptions for the patient.
31. The system of claim 1 further comprising: a screen associated
with the means for displaying wherein the screen includes
hemodialysis information.
32. The system of claim 1 further comprising: a screen associated
with the means for displaying wherein the screen includes
information for the patient to effect ordering of a
prescription.
33. The system of claim 1 further comprising: a screen associated
with the means for displaying wherein the screen includes a
peritoneal dialysis window for the patient.
34. The system of claim 1 further comprising: a screen associated
with the means for displaying wherein the screen relates to
compliance information of the patient.
35. A method for a user to track and manage a history of a patient
undergoing one of a plurality of therapies for a disease, the
method comprising the steps of: inputting information into a system
regarding the patient and each of the plurality of therapies;
tracking the information input to the system regarding the patient
and each of the plurality of therapies; and collecting data
relating to the patient wherein the data relates to the plurality
of therapies of the patient.
36. The method of claim 35 wherein one of the plurality of
therapies is peritoneal dialysis.
37. The method of claim 35 wherein one of the plurality of
therapies is hemodialysis.
38. The method of claim 35 further comprising the step of:
displaying data relating to the health of the patient.
39. The method of claim 35 wherein the disease is renal
disease.
40. The method of claim 35 wherein the disease is chronic kidney
disease.
41. The method of claim 35 further comprising the step of:
summarizing information for the patient based on the collected
data.
42. The method of claim 35 further comprising the step of:
identifying a medication for the patient.
43. The method of claim 35 further comprising the step of:
displaying a history of medications received by the patient.
44. The method of claim 35 further comprising the step of:
displaying a history of treatment of the patient.
45. The method of claim 35 further comprising the step of:
displaying a history of infections of the patient.
46. The method of claim 35 further comprising the step of:
displaying non-infection problems associated with the patient.
47. The method of claim 35 further comprising the step of:
inputting hospitalization information regarding the patient.
48. The method of claim 35 further comprising the step of:
displaying a hospitalization summary for the patient.
49. The method of claim 35 further comprising the step of:
providing a plurality of display screens to display the
information.
50. The method of claim 35 further comprising: creating a chronic
kidney disease planning pathway for the patient.
51. The method of claim 35 further comprising the step of:
providing a window for the patient to effect ordering of a
prescription.
52. The method of claim 35 further comprising the step of:
providing a hemodialysis window to evaluate treatment of the
patient.
53. The method of claim 35 further comprising the step of:
providing a peritoneal dialysis window to evaluate treatment of the
patient.
54. The method of claim 35 further comprising the step of:
providing a peritoneal dialysis window to evaluate compliance of
the patient with the treatment.
Description
BACKGROUND OF THE INVENTION
[0001] The present invention generally relates to a system and
method for tracking a patient. More specifically, the present
invention relates to a system and a method for tracking patients
throughout their therapy lifetime. Specifically, the system and the
method of the present invention is particularly applicable for
patients whose care and/or treatment may vary in location or types
of treatment which may result from the changing conditions of the
patient. More specifically, the present invention relates to a
system and method for tracking patient history for renal patients
from the initial diagnosis of the patient of chronic kidney disease
(CKD) through a therapy lifetime of a patient, i.e. CKD, peritoneal
dialysis (PD), hemodialysis (HD) and/or transplant. Further, the
present invention relates to a system and a method for tracking,
managing and/or summarizing information relating to PD and/or HD,
including access placement, infections, medications and/or
hospitalization.
[0002] It is, of course, generally known to track the history of a
patient treated for a specific disease, ailment, condition,
therapy, or the like. Usually, information regarding the patient is
recorded by a healthcare professional, such as, a doctor, a nurse,
or the like. Typically, paper or a chart is used for the doctor or
nurse to input information regarding the patient during treatment
and/or therapy. More recently, computers are implemented to record
and to store information regarding a patient. The information may
be input during a patient's visit or subsequently by office
personnel, for example.
[0003] Typically, in the case of a patient suffering from renal
disease, often the various therapies required by the patient
throughout the lifetime of the patient are separately tracked but
not otherwise combined. Often, information from previous therapies
are necessary to completely ascertain and/or to accurately evaluate
the patient, the history of therapy to the patient and to diagnose
and/or advise further treatment or the like for the patient. To do
this, information recorded on paper or the separate software
systems must be entered into other databases or other software
tools and/or re-entered by viewing the appropriate history of
interest of a particular patient. Further consideration in the
treatment or therapy which the patient is seeking through an
appropriate physician, facility, or other healthcare technician,
professional, or the like may then be necessary.
[0004] Currently, a patient may be assigned to a nephrologist or
physician to obtain a specific treatment or therapy as that
treatment or therapy relates to the condition of the patient. To
assign a new physician to a patient currently requires manual
re-assignment of the patient and/or the records associated with
that patient to the extent that any records have been previously
recorded and/or exist. The new physician, therefore, has no access
to any treatment history in electronic format and that information
must be printed and entered manually by the new physician.
Moreover, often various codes are created for a particular therapy
for a given patient. As a result, the physician or other healthcare
professional must manually enter data which may not be easily
updated if a new set of codes had been created.
[0005] More and more, various therapies are conducted by a patient
in the home of the patient. However, limitations exist regarding
the types of therapy and the extent of particular therapies that
may be administered to the patient at home. These limitations are
often due to the inability to collect information regarding the
patient and the machine that may be administering therapy to the
patient as well as limitations that may be communicated to/from a
dialysis center, for example, to the patient within the home.
Moreover, certain patients may receive therapy at the home and
subsequent therapy at another location due to changes in condition
of the patient. However, as set forth above, the information
regarding the therapy is not often readily available or
transferable with the patient. As a result, necessary information
regarding the particular stage or condition of the patient and/or
the therapy of the patient is often misunderstood or inadequately
assessed.
[0006] Still further, physicians often lack the understanding
necessary to treat a patient. As a result, patients are not
identified, characterized or channeled into care pathways by the
physician due to a lack of necessary understanding of the patient
by the physician to effectively and/or accurately direct the same.
Chronic Kidney Disease (CKD) care pathways are not generally
accurately tracked or evaluated particularly with respect to renal
disease, hypertension, anemia, CKD education, dialysis initiation,
lipid disorders, diabetes mellitus, morbidities planning, and the
like. Moreover, software that provides a unified clinical and
encounter summary screen is not available which often results in a
failure to provide tracking of a continuum of care for renal
patients within a single database.
[0007] Current existing renal-related clinical software used, for
example, at dialysis centers by dialysis providers, are not simple
to use, are not flexible in their reporting capabilities and are
not integrateable with other renal-related clinical software. As a
result, use of existing software to treat dialysis patients fails
to provide continuity of care and data capture relating to patient
and/or the therapy of the patient. Moreover, data that is captured
is not standardized making the captured data difficult to interpret
and/or transferable to other healthcare providers. Non-standardized
data results in inefficient data retrieval and often excess or
unnecessary data that may be input or otherwise targeted. Further,
the organization of the care of the patient is, therefore,
sacrificed due to an inability to track consistent information
regarding patient care and therapies undergone by the patient.
[0008] A need, therefore, exists for an improved integrated tool to
manage patients. More specifically, a need, exists for a system and
a method for managing renal patients from CKD through PD, HD to
transplant throughout the different points of clinical encounter
experienced by the patient.
SUMMARY OF THE INVENTION
[0009] The present invention provides a system and a method for
treating, tracking and/or evaluating a patient. More specifically,
the present invention relates to a system and a method for
electronically tracking and managing the treatment or therapy
associated with a patient, particularly a patient undergoing renal
therapy and providing care pathways for Chronic Kidney Disease
(CKD), PD, HD and transplant.
[0010] To this end, in an embodiment of the present invention, a
system is provided to track and manage information regarding a
patient undergoing a plurality of therapies therapy for a disease.
The system has an input means for receiving the information
regarding the patient and the plurality of therapies wherein the
patient receives at least one of the plurality of therapies to
treat the disease wherein the information is tracked and managed
for the patient for each of the plurality of therapies. The system
also has means for displaying the information related to each of
the plurality of therapies relating to the disease of the
patient.
[0011] In an embodiment, one of the plurality of therapies relates
to peritoneal dialysis.
[0012] In an embodiment, one of the plurality of therapies relates
to hemodialysis.
[0013] In an embodiment, the information is input by a healthcare
professional.
[0014] In an embodiment, the information is input by the
patient.
[0015] In an embodiment, the system has a screen associated with
the display means wherein the information includes data relating to
treatment of the patient.
[0016] In an embodiment, the system has a screen associated with
the display means wherein the information includes data relating to
a problem associated with the patient.
[0017] In an embodiment, the system has a screen associated with
the display means wherein the information includes data relating to
hospital admission of the patient.
[0018] In an embodiment, the system has a screen associated with
the display means wherein the information includes data relating to
an implant detail of the patient.
[0019] In an embodiment, the system has a screen associated with
the display means wherein the information includes data relating to
a clinical assessment of the patient.
[0020] In an embodiment, the system has a screen associated with
the display means wherein the information includes data relating to
a dynamic assessment of the patient.
[0021] In an embodiment, the system has a screen associated with
the display means wherein the information includes data relating to
an infection of the patient.
[0022] In an embodiment, the system has a screen associated with
the display means wherein the information includes data relating to
a medication for the patient.
[0023] In an embodiment, the system has a screen associated with
the display means wherein the information displayed includes data
relating to planning dialysis care for the patient.
[0024] In an embodiment, the system has a screen associated with
the display means wherein the information includes a compliance
factor.
[0025] In an embodiment, the disease is renal disease.
[0026] In an embodiment, the therapy corresponds to at least one of
chronic kidney disease, peritoneal dialysis, hemodialysis and
transplant.
[0027] In an embodiment, the system has a screen associated with
the display means wherein the information includes a history of
medications for the patient.
[0028] In an embodiment, the system has a screen associated with
the display means wherein the screen includes a treatment summary
for the patient receiving one of the plurality of therapies for the
disease.
[0029] In an embodiment, the system has a screen associated with
the display means wherein the screen includes a treatment summary
for the patient receiving one of the plurality of therapies for the
disease wherein the treatment summary includes a history of
treatment for the patient.
[0030] In an embodiment, the system has a screen associated with
the display means wherein the screen includes a treatment summary
for the patient receiving one of the plurality of therapies for the
disease wherein the treatment summary includes a history of
infections for the patient.
[0031] In an embodiment, the system has a screen associated with
the display means wherein the screen includes a treatment summary
for the patient receiving one of the plurality of therapies for the
disease wherein the treatment summary includes access information
for the patient.
[0032] In an embodiment, the system has a screen associated with
the display means wherein the screen includes a treatment summary
for the patient receiving one of the plurality of therapies for the
disease wherein the treatment summary includes information relating
to a center at which the patient receives one of the plurality of
therapies for the disease.
[0033] In an embodiment, the system has a screen associated with
the display means wherein the screen includes a treatment summary
for the patient receiving one of the plurality of therapies for the
disease wherein the treatment summary includes a hospitalization
summary for the patient receiving one of the plurality of therapies
for the disease.
[0034] In an embodiment, the input means for receiving the
information is retrievable on a plurality of display screens.
[0035] In an embodiment, the system has an access tab screen on the
means for displaying wherein the access tab screen displays a
summary of implant details for the patient.
[0036] In an embodiment, the system has an access tab screen on the
means for displaying wherein the access tab screen displays a
summary of clinical assessments for the patient.
[0037] In an embodiment, the system has an access tab screen on the
means for displaying wherein the access tab screen displays a
summary of dynamic assessments for the patient.
[0038] In an embodiment, the system has a chronic kidney disease
planning pathway for the patient.
[0039] In an embodiment, the system has a screen associated with
the means for displaying wherein the screen includes information to
order prescriptions for the patient.
[0040] In an embodiment, the system has a screen associated with
the means for displaying wherein the screen includes hemodialysis
information.
[0041] In an embodiment, the system has a screen associated with
the means for displaying wherein the screen includes information
for the patient to effect ordering of a prescription.
[0042] In an embodiment, the system has a screen associated with
the means for displaying wherein the screen includes a peritoneal
dialysis window for the patient.
[0043] In an embodiment, the system has a screen associated with
the means for displaying wherein the screen relates to compliance
information of the patient.
[0044] In another embodiment of the present invention, a method is
provided for a user to track and manage a history of a patient
undergoing one of a plurality of therapies for a disease. The
method comprises the steps of: inputting information into a system
regarding the patient and each of the plurality of therapies;
tracking the information input to the system regarding the patient
and each of the plurality of therapies; and collecting data
relating to the patient wherein the data relates to the plurality
of therapies of the patient.
[0045] In an embodiment, one of the plurality of therapies is
peritoneal dialysis.
[0046] In an embodiment, one of the plurality of therapies is
hemodialysis.
[0047] In an embodiment, the method further has the step of
displaying data relating to the health of the patient.
[0048] In an embodiment, the disease is renal disease.
[0049] In an embodiment, the disease is chronic kidney disease.
[0050] In an embodiment, the method further has the step of
summarizing information for the patient based on the collected
data.
[0051] In an embodiment, the method further has the step of
identifying a medication for the patient.
[0052] In an embodiment, the method further has the step of
displaying a history of medications received by the patient.
[0053] In an embodiment, the method further has the step of
displaying a history of treatment of the patient.
[0054] In an embodiment, the method further has the step of
displaying a history of infections of the patient.
[0055] In an embodiment, the method further has the step of
displaying non-infection problems associated with the patient.
[0056] In an embodiment, the method further has the step of
inputting hospitalization information regarding the patient.
[0057] In an embodiment, the method further has the step of
displaying a hospitalization summary for the patient.
[0058] In an embodiment, the method further has the step of
providing a plurality of display screens to display the
information.
[0059] In an embodiment, the method further has the step of
creating a chronic kidney disease planning pathway for the
patient.
[0060] In an embodiment, the method further has the step of
providing a window for the patient to effect ordering of a
prescription.
[0061] In an embodiment, the method further has the step of
providing a hemodialysis window to evaluate treatment of the
patient.
[0062] In an embodiment, the method further has the step of
providing a peritoneal dialysis window to evaluate treatment of the
patient.
[0063] In an embodiment, the method further has the step of
providing a peritoneal dialysis window to evaluate compliance of
the patient with the treatment.
[0064] It is, therefore, an advantage of the present invention to
provide a system and a method for providing care to a patient.
[0065] Another advantage of the present invention is to provide a
system and a method for tracking care or therapy to a patient.
[0066] And, another advantage of the present invention is to
provide a system and a method for determining care pathways for
Chronic Kidney Disease.
[0067] Yet another advantage of the present invention is to provide
a system and a method for accurately summarizing care, treatment
and/or therapy provided to a patient.
[0068] A still further advantage of the present invention is to
provide a system and a method to evaluate and/or to capture PD, HD
and transplant eligibility.
[0069] Yet another advantage of the present invention is to provide
a system and a method for treating a patient implementing a
comprehensive integrated software that covers a continuum of care
for the renal patient within a single database.
[0070] Moreover, an advantage of the present invention is to
provide a system and a method for standardizing dosage templates
using a medication dictionary to automatically create a medication
resulting in reduced time and/or keystrokes necessary to effect
creation of the medication and to improve standardization of the
same.
[0071] Moreover, an advantage of the present invention is to
provide a system and a method for sending a description and/or
supply order electronically and securely.
[0072] A further advantage of the present invention is to provide a
system and a method for creating reports regarding a patient where
the reports are dynamic and are able to be modified via sorting and
row and/or column placement.
[0073] A still further advantage of the present invention is to
provide a system and a method for identifying a reason for
discordance between patient choice and final choice through
dialysis modality.
[0074] Yet another advantage of the present invention is to provide
an integrated access management program for PD and HD patients.
[0075] A still further advantage of the present invention is to
provide a system and a method for monitoring a patient via the
Internet or a modem.
[0076] And, another advantage of the present invention is to
provide a system and a method that allows customization and access
to components of the dialysis software with respect to a
patient.
[0077] A further advantage of the present invention is to provide a
system and a method for transferring a patient from one physician
to another physician or other healthcare provider.
[0078] Yet another advantage of the present invention is to provide
a system and a method for transferring a patient from one database
to another database without losing or otherwise requiring separate
input of information regarding the patient.
[0079] Yet another advantage of the present invention is to provide
a system and a method for identifying routine laboratory tests
and/or simplified comparison of pre-treatment results and/or
post-treatment results.
[0080] A still further advantage of the present invention is to
provide a system and a method for identifying care givers
associated with a particular patient to enhance the assignment of a
patient care team.
[0081] Moreover, an advantage of the present invention is to
provide a system and a method that allows multiple facilities to
use one database with different security profiles.
[0082] Yet another advantage of the present invention is to provide
a system and a method that provides customized viewing and/or
access rights for each member of a renal care team.
[0083] A still further advantage of the present invention is to
provide a system and a method for managing access sites for a
patient undergoing treatment for peritoneal dialysis (PD) or
hemodialysis (HD).
[0084] A further advantage of the present invention is to provide a
system and a method for access information of for a patient
undergoing treatment for peritoneal dialysis (PD) or hemodialysis
(HD), the information relating to access placement, infection
problems, non-infection problems, medications, and/or
hospitalizations.
[0085] Yet another advantage of the present invention is to provide
a system and a method that provides simple tracking of PD and HD
management in a single module.
[0086] Still another advantage of the present invention is to
provide a system and a method that provides a display of the
history surrounding the access management system.
[0087] Another advantage of the present invention is to provide a
system and a method that provides a display of the treatment
history for a patient.
[0088] Yet another advantage of the present invention is to provide
a system and a method that provides a display of the
hospitalization history for a patient.
[0089] Still another advantage of the present invention is to
provide a system and a method that provides a display of the access
history for a patient.
[0090] Additional features and advantages of the present invention
are described in, and will be apparent from, the detailed
description of the presently preferred embodiments and from the
drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0091] FIG. 1 illustrates a block diagram of a system in an
embodiment of the present invention.
[0092] FIG. 2 illustrates a black box diagram associated with
treatment of a patient in an embodiment of the present
invention.
[0093] FIG. 3 illustrates a diagram of modules for tracking and/or
monitoring a patient throughout the various stages of renal disease
in an embodiment of the present invention.
[0094] FIG. 4 illustrates a flowchart for identifying care pathways
in an embodiment of the present invention.
[0095] FIG. 5 illustrates a flowchart for identifying care pathways
in an embodiment of the present invention.
[0096] FIG. 6 illustrates a flowchart for identifying care pathways
in an embodiment of the present invention.
[0097] FIG. 7 illustrates a center and patient demographic screen
in an embodiment of the present invention.
[0098] FIG. 8 illustrates a screen that prompts input or
information regarding a clinical encounter in an embodiment of the
present invention.
[0099] FIG. 9 illustrates a screen relating to a CKD care pathway
in an embodiment of the present invention.
[0100] FIG. 10 illustrates a screen relating to a CKD care pathway
in an embodiment of the present invention.
[0101] FIG. 11 illustrates a block diagram of a method for tracking
patient activity in an embodiment of the present invention.
[0102] FIG. 12 illustrates a new entry screen in an embodiment of
the present invention.
[0103] FIG. 13 illustrates a patient re-assignment screen in an
embodiment of the present invention.
[0104] FIG. 14 illustrates a patient transfer screen in an
embodiment of the present invention.
[0105] FIG. 15 illustrates a patient transfer screen in an
embodiment of the present invention.
[0106] FIG. 16 illustrates an information import screen in an
embodiment of the present invention.
[0107] FIG. 17 illustrates an import and maintenance screen in an
embodiment of the present invention.
[0108] FIG. 18 illustrates an import and maintenance screen in an
embodiment of the present invention.
[0109] FIG. 19 illustrates an import and maintenance screen in an
embodiment of the present invention.
[0110] FIG. 20 illustrates a clinical history screen in an
embodiment of the present invention.
[0111] FIG. 21 illustrates a patient demographic screen in an
embodiment of the present invention.
[0112] FIG. 22 illustrates a clinical history screen in an
embodiment of the present invention.
[0113] FIG. 23 illustrates a medications maintenance screen in an
embodiment of the present invention.
[0114] FIG. 24 illustrates a screen which prompts a user to add
information to a patient file in an embodiment of the present
invention.
[0115] FIG. 25 illustrates a screen which prompts a user to add
information to a patient file in an embodiment of the present
invention.
[0116] FIG. 26 illustrates a screen which prompts a user to select
a font in an embodiment of the present invention.
[0117] FIG. 27 illustrates a screen which prompts a user to select
a mode related to filling of a prescription in an embodiment of the
present invention.
[0118] FIG. 28 illustrates a screen which provides therapy
parameters in an embodiment of the present invention.
[0119] FIG. 29 illustrates a screen which contains nurse
information in an embodiment of the present invention.
[0120] FIG. 30 illustrates a screen which provides therapy
solutions and manual exchanges in an embodiment of the present
invention.
[0121] FIG. 31 illustrates a screen which enables a user to adjust
information within the system in an embodiment of the present
invention.
[0122] FIG. 32 illustrates a screen which provides prompts and
special fields to a -user in an embodiment of the present
invention.
[0123] FIG. 33 illustrates a screen which contains prescription
information in an embodiment of the present invention.
[0124] FIG. 34 illustrates a screen which contains supply chain
information in an embodiment of the present invention.
[0125] FIG. 35 illustrates a screen which enables a user to select
a mode of therapy in an embodiment of the present invention.
[0126] FIG. 36 illustrates a block diagram of supply chain
integration in an embodiment of the present invention.
[0127] FIG. 37 illustrates user requirement specifications for
effecting delivery of prescriptions and prescription information
via a supply chain in an embodiment of the present invention.
[0128] FIG. 38 illustrates user requirement specifications for
effecting delivery of prescriptions and prescription information
via a supply chain in an embodiment of the present invention.
[0129] FIG. 39 illustrates a block diagram of a method for
capturing a clinical encounter in an embodiment of the present
invention.
[0130] FIG. 40 illustrates a block diagram of a method for
monitoring care pathways in an embodiment of the present
invention.
[0131] FIGS. 41-49 illustrate block diagrams of tracking that
occurs through the clinical and care pathways for the dialysis
patient in an embodiment of the present invention.
[0132] FIG. 50 illustrates a screen that pops up as a reminder
regarding specific items that must be completed in a "to-do list"
format in an embodiment of the present invention.
[0133] FIG. 51 illustrates a screen containing clinical encounter
information in an embodiment of the present invention.
[0134] FIG. 52 illustrates a screen containing clinical pathway
information in an embodiment of the present invention.
[0135] FIG. 53 illustrates a screen containing a diabetes mellitus
pathway in an embodiment of the present invention.
[0136] FIG. 54 illustrates a screen containing a mineral metabolism
pathway in an embodiment of the present invention.
[0137] FIG. 55 illustrates a screen containing education tracking
in an embodiment of the present invention.
[0138] FIG. 56 illustrates a screen containing education assessment
in an embodiment of the present invention.
[0139] FIGS. 57(a) and 57(b) illustrate a screen containing care
pathway information for modality eligibility and/or planning in an
embodiment of the present invention.
[0140] FIGS. 58 (a) and 58(b) illustrate a screen relating to
modality choice which indicates a care giver's opinion for which
therapy should be chosen for the patient based on eligibility
criteria or patient discussion in an embodiment of the present
invention.
[0141] FIG. 59 illustrates a screen for access planning to note a
type of dialysis access chosen in an embodiment of the present
invention.
[0142] FIGS. 60(a) and 60(b) illustrate dialysis initiation screens
which track a type of dialysis access in an embodiment of the
present invention.
[0143] FIGS. 61(a) through 61(f) illustrate charts defining various
care pathway assignments based on various laboratory results in an
embodiment of the present invention.
[0144] FIG. 62 illustrates a clinical pathway screen relating to
preventative measures in an embodiment of the present
invention.
[0145] FIG. 63 illustrates a nutrition pathway screen in an
embodiment of the present invention.
[0146] FIG. 64 illustrates a clinical pathway screen for lipid
disorders in an embodiment of the present invention.
[0147] FIG. 65 illustrates a hypertension pathway screen in an
embodiment of the present invention.
[0148] FIG. 66 illustrates an anemia pathway screen in an
embodiment of the present invention.
[0149] FIG. 67 illustrates an access summary screen in an
embodiment of the present invention.
[0150] FIG. 68 illustrates a treatment history screen in an
embodiment of the present invention.
[0151] FIG. 69 illustrates a hospitalization summary screen in an
embodiment of the present invention.
[0152] FIG. 70 illustrates an access screen containing implant
details of a patient in an embodiment of the present invention.
[0153] FIG. 71 illustrates an access screen containing clinical
assessment of a patient in an embodiment of the present
invention.
[0154] FIG. 72 illustrates an access screen containing culture
sample indicators in an embodiment of the present invention.
[0155] FIG. 73 illustrates an access screen containing dynamic
assessments of a patient receiving hemodialysis in an embodiment of
the present invention.
[0156] FIG. 74 illustrates an access screen containing dynamic
assessments of a patient receiving peritoneal dialysis in an
embodiment of the present invention.
[0157] FIG. 75 illustrates a screen containing infection data in an
embodiment of the present invention.
[0158] FIG. 76 illustrates a screen containing non-infection
problem data in an embodiment of the present invention.
[0159] FIG. 77 illustrates a screen containing medications data in
an embodiment of the present invention.
[0160] FIG. 78 illustrates a screen containing hospitalization data
in an embodiment of the present invention.
[0161] FIG. 79 illustrates a CKD access planning screen in an
embodiment of the present invention.
[0162] FIG. 80 illustrates a screen containing hemodialysis
prescription information in an embodiment of the present
invention.
[0163] FIG. 81 illustrates a screen containing hemodialysis
treatment information in an embodiment of the present
invention.
[0164] FIG. 82 illustrates a screen containing PD prescription
information in an embodiment of the present invention.
[0165] FIG. 83 illustrates a screen containing PD compliance
information in an embodiment of the present invention.
DETAILED DESCRIPTION OF THE PRESENTLY PREFERRED EMBODIMENTS
[0166] The present invention relates to a system and a method for
providing care and or therapy to a patient. Moreover, the present
invention provides a system and a method for tracking care or
therapy to a patient, particularly a patient with renal disease.
More specifically, the present invention relates to a system and a
method for tracking therapies and/or care to a patient throughout
the various stages of renal disease, particularly Chronic Kidney
Disease (CKD).
[0167] The present invention generally relates to a system 1 that
may be integrated such that a patient undergoing therapy has a
history that tracks the patient during any stage of that therapy
using the system 1. As illustrated in FIG. 1, the system 1 is
integrated such that a patient 10 or a group of patients 10 or a
center 12, such has a hemodialysis center, are integrated within
the system 1. The demographics and clinical history of each of the
patients 10 and each of the centers 12 are included within the
integrated system 1 such that the patient 10 is tracked throughout
any stage of renal disease, particularly chronic kidney dialysis
(CKD module)16, peritoneal dialysis (PD module) 18, hemodialysis
(HD module) 20, and/or transplant (T module) 22. The integrated
system 1 also generates reports 24 and has multiple interfaces 26
with external resources or other processes relevant to the care of
the patient 10. Demographics 14a of the patient 10 may be input
into the system 1 such that the patient 10 may be identified at
least by name, birth date, age, gender and/or other identifiers.
The clinical history 14b within the integrated system 1 is capable
of tracking history of the patient 10 from the onset of care. The
clinical history 14b may include events, descriptions and/or dates.
In addition, descriptions and/or dates of the following may be
included: co-morbidities, hospitalizations, medications, surgeries
and/or labs.
[0168] Within the CKD module 16 of the system 1, the status of
renal function, related complications, co-morbidities profiling,
medications/lab tracking and the like may be identified. Within the
PD module 18, access, prescription, complications or infections or
other information, patient status, compliance, summary reports as
well as other functions and other information may be provided.
Within the hemodialysis module 20, similar information, namely,
description, complications, infections, catheter information,
patient status, compliance, reports and other functions and
information may be tracked. Within the transplant module 22, a
transplant patient identifier, a history of treatment, as well as
medication/lab tracking and/or co-morbidities tracking may be
provided. The reports 24 with any portion of the system 1 may
include physician, nurse, administrative and/or ad hoc reports. An
interface 26 may be provided within the system 1 to link with other
clinical systems, laboratories, supply chains, and/or other service
requirements.
[0169] FIG. 2 generally illustrates the cycle of a patient. An
at-risk patient 10 may be diagnosed at step 2 as a patient with
chronic kidney disease (CKD). Step 3 is a dialysis section wherein
the patient undergoes one of home hemodialysis as shown within Step
3 at 3a, peritoneal dialysis (PD) at 3b, or in-center or hospital
therapy as shown at 3c. At step 4, some patients may be identified
as requiring organ replacement or transplant. As shown in FIG. 2,
at the diagnosis step, CKD may be identified, characterized and/or
patients may be channeled into care pathways utilizing educational
and medical guidelines. To this end, physicians may gain an
understanding of the patient and patient adjustment may be enhanced
through education. As a result, dialysis may be initiated in a
timely manner and/or clinical outcomes may be improved.
[0170] If PD is suggested and/or required for the patient, a link
is provided resulting in continuity of care for the patient and
monitoring of the patient through continuous monitoring of the
patient and automated transfer of the information regarding the
patient into the system 1. A patient may also be monitored for
compliance to prescribed versus delivered therapy during PD. As a
result, enhanced problem identification and/or simplified patient
training may be provided. In addition, home hemodialysis monitoring
may be provided resulting in real-time monitoring of the patient
during dialysis. A physician or other medical or clinical staff may
link to the home of a patient via the internet or modem.
[0171] As shown in FIG. 3, the system 1 of the present invention
provides centralized electronic medical history and demographic
information that is integrally installed on a single platform with
data import, data input, and data export capabilities with a
laboratory and/or registries and the like. Prescription and order
management may also be provided as well as report management.
[0172] Within the system 1, certain functions may be activated or
deactivated depending on the particular patient. First, the patient
may be identified as a patient with chronic kidney disease and may
require peritoneal dialysis, in-center hemodialysis, and/or home
hemodialysis. Prescription modeling and/or access management may be
provided as required depending on the type or types of therapy
which the patient may be undergoing. Further, a transplant module
may also be activated or deactivated based on the particular
patient.
[0173] The system 1 of the present invention may be implemented to
provide a single system and method for tracking and/or monitoring a
patient throughout the various stages of renal disease and to
identify the appropriate pathways for each patient and organizing
the care standardization of data capture resulting in the
continuity of care and data capture for each patient, as well as
efficient data retrieval and targeted data exploration for the
patient.
[0174] As shown in FIG. 4, an approach or method using the system 1
and method of the present invention results from unified center and
patient demographics input into the system and streamlining the
clinical encounter captured as a result of use of the system and
method of the present invention. FIG. 4 shows common care pathways
identified for each of CKD, PD, HD and transplant. As a result of
those particular identifications, specific care pathways may then
be identified for each patient within each category of treatment,
namely, CKD, PD, HD and transplant.
[0175] FIG. 5 illustrates an alternate approach in which unified
center and patient demographics are obtained through streamlining
clinical encounter capture for each of CKD, PD, HD and transplant
therapies and common pathways for various data identified, tracked
and/or otherwise addressed, such as hypertension, mineral, lipid
and/or nutrition.
[0176] As shown in FIG. 6, another approach through unified center
and patient demographic input through streamlined clinical
encounter capture for each of CKD, PD, HD and transplant
treatments, various pathways are identified such as, for example,
anemia, providing pathway access to subsequent pathways for renal
protection.
[0177] FIG. 7 illustrates an embodiment of a center and patient
demographic screen for a particular patient. The screen provides
for input via tabs 30 for various demographic information for a
particular patient such as professional contact information and
emergency contact information, employment information, insurance
information, personal information, address information, telephone
or e-mail information, and the like.
[0178] FIG. 8 illustrates a screen that prompts input or
information regarding clinical encounter. Various tabs are
provided, such as the encounter summary tab 32 which identifies
various information regarding the specific encounter of the
particular patient by the physician or other medical professional
treating the patient. The tabs may include information regarding
summarizing the encounter, information regarding renal disease,
system review and/or physical assessment of the patient.
[0179] A care pathway may then be identified for the particular
patient identified by various tabs or, for example, hypertension
(HPT), lipid disorders, nutrition, preventative, renal disease,
anemia, diabetes mellitus and/or mineral metabolism, and the like
as shown in FIG. 9. Additional care pathways may also be provided
for a patient, such as tabs for access planning, dialysis
initiation, transplant, educational assessment, CKD education, and
modality as shown in FIG. 10.
[0180] FIG. 11 illustrates a method 100 for using the system 1 of
the present invention. A first step is identified at step 102 where
data collection and device connectivity are provided. Data may be
collected through manual input via, for example, the integrated
software of the system 1 requiring patient input or center input or
other user input as shown at step 101. The input may also be
provided via, for example, a personal digital assistant or other
wireless input device. Alternatively or in addition, machine input
may be provided by direct monitoring, for example, of a patient
within a center. Or, for example, if home hemodialysis is taking
place, the information may be transferred, data may be collected
and/or moved to and/or from multiple patients without regard to the
type of therapy which the patient may be undergoing during any
stage of the renal disease of the patient.
[0181] Internet connectivity with a consolidated database may be
provided as shown at step 104. The internet connectivity may be
provided at a data hub providing information to the internet via a
browser. Or, a server database may be provided that may provide the
necessary legal, privacy, security and/or regulatory issues for the
monitoring of the patient through the various stages of renal
disease. Connected to the internet are various software
applications as shown at step 106 wherein information may be
downloaded to and/or from the software to provide the necessary
processing of the data for any type of renal disease that the
patient may be experiencing. The method provides multiple
accessibility as shown at step 108 or multiple users and multiple
tools. Among the users may be the patient, a clinician or other
medical or technical professional. A provider, a supplier, a
laboratory or other corporate or professional resource may also be
defined as a "user." Multiple tools may also be provided to assist
with the administration of care to the patient throughout each
stage of the renal disease that may be experienced by the patient.
For example, tools that may be used to assist the patient or any
other users include a computer, e-mail, telephone, telefax, or the
like.
[0182] The final step 110 of the method 100 results in various
outcomes that may be provided as a result of the method of the
present invention as illustrated in FIG. 11. The patient may be
tracked through his/her therapy lifetime. In addition, the system
and method of the present invention tracks multiple patients
through their therapy lifetimes. The history of patients is not
lost as the patient is transferred from one therapy option to
another option. In addition, all history from the CKD phase may be
transferred with the patient or patients to the dialysis and/or
transplant care professionals, or medical care clinicians or other
professionals. The system and the method provides a comprehensive
integrated software tool that allows renal patient data to be
transferred from the CKD phase to the patient's first therapy
option to ensure continuity in treatment history.
[0183] All therapy options may be recorded within the software so
patients may be transferred to and from PD, HD, and/or transplant
therapies without losing previous treatment history. Clinical and
therapeutic features include the managing and/or monitoring of CKD
patients to track renal disease progression and/or complications.
Data may be recorded for therapy option education, modality
selection, and/or access placement preparation. In addition,
clinical patient management may be provided to track medications
and/or monitor compliance. Further, complications and/or infections
may be tracked. Further, co-morbidities may be managed; and
clinical assessment and/or history of the patient may be monitored.
As a result, the organization of the delivery of care may be
enhanced by creating a single source for all clinical information.
Timely initiation of dialysis may also be provided that may reduce
urgent start of the particular dialysis therapy, improved
clearances, as well as saved medical professional time for
physicians, nurses, or other medical professionals.
[0184] From an operational and administrative standpoint, data may
be captured from machines and other sources. Captured data may be
accessed and/or exchanged remotely. Remote access and/or exchange
include clinical data and/or machine parameters via two-way
communication. Moreover, data may also be automatically imported,
and the data may also be exported. Dialysis product supply
management may be enabled resulting in electronically presenting
new patients and/or creating initial orders. Further, prescriptions
may be automatically submitted to, for example, suppliers. Still
further, remote diagnostics of dialysis devices may be provided
through the system and method of the present invention to determine
and/or solve problems associated with, for example, showing which
patient may be connected. Problems may be determined and/or fixed
with, for example, a modem and/or the internet. As a result, a
single source for clinical data and/or machine data may be created.
Patients visits may be reduced and annual data entry may be
eliminated. Administrative time and paperwork, as well as human
errors, may also be reduced and/or saved. From a patient's
standpoint, anxiety or hassle that a patient may experience may be
lessened or eliminated. Moreover, missed exchanges required by the
patient may be reduced and/or eliminated.
[0185] To initiate use of the system and method of the present
invention, an entry screen, as illustrated in FIG. 12, may be
provided. The patient entry screen provides customization as well
as access to all components of the system and method of the present
invention.
[0186] FIGS. 13-15 illustrate screens for transferring or
re-assigning patients from one physician to another physician. As a
result, patients may be transferred between physicians in a
simplified fashion. The records of the patient are also transferred
to the new physician and access may be provided through the records
or the patient from the previous physician.
[0187] First, as illustrated in FIG. 13, the patient reassignment
is performed by identifying the current physician of the patient.
The physician's name may be identified as part of a drop down menu
of physicians already input to the system of the present invention.
The new physician may be identified in a second area of the screen
which may also be provided in a drop down menu of physicians
already input into the system.
[0188] As shown in FIG. 14, the patient transfer may be affected by
importing and/or exporting patient data which may be password
protected as shown in FIG. 14. One or more patients may be exported
by the user by identifying patient name, a patient list, and
transferring information from the patient list to the selected
patient list for transfer of the patient.
[0189] Following transfer of the patient, as illustrated in FIG.
15, the user is notified that the export of the patient has been
successful. The user may print a patient transfer summary report
which may include various customized pieces of information. The
report information for a particular patient may be customized as
will be discussed hereinafter. It should be understood and
appreciated that any report or function of the system may be
customized as desired for the particular patient and/or the center
and/or the medical professional or other user.
[0190] Another feature of the present invention is generally
illustrated with respect to FIGS. 16-19 which provides for import
and/or maintenance capabilities for diagnosis codes (ICD or
registries) which may differ by module, ie, CKD, PD, HD and
transplant.
[0191] As shown in FIG. 16, the installed import modules can be
identified and imported. Diagnosis code maintenance may be provided
to identify, for example, various codes associated with, for
example, hypertension, as illustrated in FIG. 18. FIG. 19
illustrates, for example, existing diagnosis codes within the renal
link which may be used to identify the particular code for word
and/or maintenance. The diagnosis codes maintenance window adds
fields for "active", "registry", and "internal system code". In
addition, fields may be added for code type association as well as
validation rules. The validation rules may include active codes
that are unique, active descriptions that are unique and may not
delete particular rows. Ability to filter by code and/or
description may be provided a checkbox for display.
[0192] FIG. 20 generally illustrates screens for identifying
routine lab tests for renal patients and/or to provide for analysis
of pre-treatment results as well as post-treatment results. The lab
results category screens illustrated in FIG. 20 provide a database
linking category and source columns headed to test results table.
Display groups may be selected by category. The results may be
provided any column and display may be filtered to show any test
results within a specific acceptable range. Moreover, test results
may be displayed by filtering outside an acceptable range.
[0193] In addition to the foregoing, as illustrated in FIG. 21,
enhanced renal patient care team assignment maintenance may be
identified by displaying associated care givers with each renal
patient. To this end, a patient name may be identified and the
entire care team may be illustrated on the screen. As a result,
each care giver, physician, or the like, may be immediately
provided and accessed through this link.
[0194] The patient re-assignment feature, discussed above with
reference to FIGS. 14 and 15, transfers renal patient data from one
physician to another without manually re-assigning each patient to
a new nephrologist, physician or other medical professional. The
patient transfer feature transfers a CKD patient from one database
to a dialysis-transplant facility database in the integrated system
and method of the present invention. As a result, a new
nephrologist or physician may be provided with access to treatment
history in an electronic format and that history would not require
printing and/or separate manual entry by the new physician. The
import maintenance capabilities for diagnosis codes prevents manual
entry of data by the user and provides simplified updating if a new
set of codes are created.
[0195] The lab result category described with reference to FIG. 20
assists with simplified identification of routine lab tests of
renal patients and simplified comparison of pre-treatment and
post-treatment results. As a result, users may easily group routine
lab tests.
[0196] The patient care team assignment maintenance location
described with reference to FIG. 21 identifies all care givers
associated to each renal patient. As a result, one central location
provides a comprehensive function to track the team members from
CKD, dialysis, and transplant. All of the above functions described
with reference to FIGS. 12-21 are performed automatically and
replace manual processes that previously were performed by a user
that resulted in mistakes, or mis-entries or the like.
[0197] Another feature of the system and method of the present
invention includes a medication dictionary which enables a user to
create and/or save medication or prescription templates for
subsequent use and/or recording and/or for prescribing treatment to
a patient. FIGS. 22 and 23 illustrate a medication screen for entry
of information in a template format. As a result, various
components of a prescription may be standardized and saved as a
"standard prescription". A series of computer dialogues are
provided by the medication dictionary to enter a configuration
name, medication, medication category, load dose, maintenance dose,
dose unit of measure, route, frequency, frequency period, PRN
(Y/N), treatment related PRN in dialysis (y/N), PRN and/or
duration. In addition to those input categories, units of measure,
route, frequency and frequency period may be presented as select
lists to assist with the standardization of configurations and/or
selections of medications for prescriptions.
[0198] FIGS. 22 and 23 illustrate screens providing medication
templates for a patient resulting in a standard prescription for a
particular patient. Fields within the medication configuration
maintenance window may be pre-populated when a configuration is
selected. Drop-down lists may be implemented to identify and assist
with completing the necessary field or fields within the
prescription window and/or medication tab. After a medication is
selected, available configurations populate the window using the
medication dictionary. The field and/or reports associated with the
medication and prescription may be manipulated like any other
report within the system 1 of the present invention as will be
described hereinafter.
[0199] The medication dictionary creates a group of standard
medication configurations for frequently prescribed medications
which may be customized for a particular patient throughout the
stages of renal disease. The medication dictionary contains
configurations for frequently prescribed medications that may be
transferred from patient to patient within each stage of renal
disease.
[0200] To effect or implement a medication dictionary, a medication
maintenance may first be selected by a system administrator wherein
the system displays a medication configuration dialogue. The system
administrator selects one of a plurality of medications, and
configurations for that medication are automatically input by the
system. The system administrator may select or identify desired
components of the medication or the particular therapy and/or the
particular patient. The system administrator may enter values for
dosage, maintenance dosage, and/or duration period. Values may be
further selected for units, frequency, frequency time period and
routes from drop-down lists for each category. In addition, the
system administrator may indicate whether medication may be given
during treatment. The medication information may then be saved, and
the system may store the same in the application database.
[0201] Moreover, medication history may be maintained with use of
the system and method of the present invention. The history and/or
medication selected by the user and current medications for the
selected patient may be displayed. The system and method of the
present invention further provides a report engine that provides
the ability to sort on any column; the ability to filter on any
column; the ability to search for text strings within a remark
field; the ability to move, hide, and/or re-arrange column; and the
ability to hide a reports sections. FIG. 24 illustrates a screen
that may prompt a user to identify the ability to add a column and
prompts for making a column by word specific "bands."After a report
is selected, sorts, additions or deletions may be affected. In
addition, text may be added as illustrated by FIG. 25 within
specific bands. Similarly, expressions may be added through a
series of prompts within the screen. Fonts within any report may
also be adjusted and modified through a font prompting screen as
generally illustrated in FIG. 26. Font may be adjusted by font
type, font style and/or font size for any report within the
system.
[0202] As previously described, the system and method of the
present invention may be executed on a computer within the home of
a patient. The PC may be connected to an instrument via a serial
connection. Alternatively, the PC may be connected to a modem and
is capable of connecting to the internet or intranet. After a PC in
the home of the patient is turned on, the system and method of the
present invention awaits a connection signal from the system
operating within, for example, a clinic. The application
automatically establishes a connection with the PC within the home
of the patient via modem or TCP/IP protocol. An approved security
algorithm communicates and receives the application through the
system. The system and method of the present invention includes the
ability to securely monitor home dialysis patients via a modem
and/or the internet. The internet may be used to eliminate long
distance charges and also add encryption on all data sent and
received on the communication pathways.
[0203] The system of the present invention uses software to
communicate with dialysis instruments within the home of the
patient. The system via the software retrieves data from the
instrument within the home. The system provides a secure way of
communicating with the instruments in patient's home via modem and
TCP/IP protocols. In addition, appropriate security is provided at
the patient's side of the system. After the connection is
established, the information from the patient's side may be
transferred and may be received via the selected communication
protocol from, for example, the clinic. The PC in the home of the
patient may be connected to the instrument via a serial connection.
For modem connections, however, a modem is attached to the PC. For
TCP/IP connections, the PC is attached to a cable modem that is
capable of reaching the internet/intranet.
[0204] The server for the system has two modules: one module for
service and the other module for the controller. The service module
provides low level communications with a network of instruments.
The collected information may be made available via an interface
for use by the system and method of the present invention. The
service module also provides automatic collection of treatment data
wherein the controller provides a graphic interface to monitor the
functionality of the system. The controller may also provide for
configuration management.
[0205] A third module may be used to provide security for the
packets sent and received in the home of the patient. The third
module may run on the PC in the home to manage the modem and TCP/IP
connections between the instrument and the clinic. The software
used at both ends of the connection adhere to Advanced Encryption
Standard (AES) for packets sent and received in the home of the
patient.
[0206] The system provides control and/or security for modem
connections to the patient. Commands may be provided for a modem
port to be assigned to a particular telephone number, status of the
connection may be queried, and the connection may be terminated.
The system may further provide control for TCP/IP connections to
the system of the patient. Commands provide for a TCP/IP resource
to be assigned to the connection, status of the connection to be
queried, and the connection to be terminated. The interfaces for
the control of the connections may be available via screens
provided by the system and method of the present invention.
[0207] The controller further provides configuration of the machine
resources for the system. The controller may write to the registry
with the appropriate resource type: modem, in-center, or TCP/IP. As
a result, the server may be configured for any of the three
resource types. Source maps may store this configuration
information, and interfaces may expose information to the system
and method of the present invention. The demographics window of the
system and method of the present invention allow a user to
configure a home patient for a modem or TCP/IP connection. A modem
checkbox in the screen of the demographics window populates a
listbox control with "modem" and/or "TCP/IP" in the checkbox. The
control is automatically enabled when the user selects "home hemo
connection" within the category list of types of treatment.
[0208] The system and method of the present invention allows a user
to assign a home patient to a modem or TCP/IP station. The menu and
the window may be changed from real time-connect/disconnect modem
to a full time, home hemo connection. After a connection is made to
the system within the home of the patient, real time monitoring of
the home system may be provided in the same manner as a machine
used at a dialysis center. If a connection is lost, the network
window may indicate the same to the user. A home station that loses
a connection may be sorted to the top of a list beneath any other
stations which may have alarms associated with the home
station.
[0209] To establish modem connections, serial connection is made
between the instrument and the PC in the home of the patient. The
modem may be set to auto answer and may be connected to the PC. The
patient's system may be started on the PC, and a port may be opened
to the modem to await a call from the clinic.
[0210] Within the clinic, the system 1 may wait for the user to
begin the call to the home of the patient. Using a home hemo
connection window, a call from the clinic may be made using the
modem connection to the PC in the clinic via telephone lines
directly to the patient's home. The modem in the home then answers
the call, and the client's system is connected to the clinic
system. Packets that may be transferred between the connection are
encrypted using AES.
[0211] After the call has ended using the connection window, the
modem in the home returns to auto-answer with a port open. At this
point, the patient's system is ready for another incoming call. The
modem in the clinic may then establish another outgoing call to
another patient.
[0212] Similarly, TCP/IP connections to the home of the patient are
established by the serial connection made between the instrument
and the PC in the home of the patient. The setup of the client's
system in the home includes the static IP address and port number
of the TCP/IP server system that runs within the clinic. The
patient's system automatically attempts to connect to the clinic
using the static IP address and port number via the cable modem
across the internet. A number of times for each attempt may be
configurable, and a default may be established for the number of
times.
[0213] Within the clinic, the system waits for the user to begin
the connection to the specific home of the patient. Using the
connection window of the system 1 and method 100 of the present
invention, a connection attempt from the clinic is made to the
system within the clinic. In the system, a switch may respond to
the connection being established from the patient's home. Through
this connection, a new thread is spawned in the system at the
clinic to continue the connection. As a result, the main connection
thread is made available to respond to other connection attempts
made by other home patient TCP/IP clients. Circuits that may be
passed between this connection may also be encrypted using AES.
[0214] After the connection is terminated, the patient's system
resets its connection thread and begins attempts to connect to the
clinic's TCP/IP server within a specific time frame, i.e. every
thirty seconds, which may be configurable and set for the patient.
The system may reset its switch preventing attempts to connect the
same from the patient's system, and all subthreads used in the
terminated connection may be dropped.
[0215] The system 1 and the method 100 of the present invention may
further guide a user to create PD prescription and/or supply chain
orders. To this end, navigation and streamline processes create
patient prescriptions based on the patient's therapy mode may be
provided. The system may step a user through logical groups of data
elements to create the new PD prescription. This example is based
on the presumption that the patient received a previous
prescription. The previous prescription data may be used as a
default, and the user may navigate among the various steps and save
a new record at any time. If this prescription is the first
prescription for the patient, the first prescription for a
different therapy mode fill mode combination and the appropriate
machine default values may be set. The user may complete each step
sequentially and save the record after completing the final
step.
[0216] In a first step, the user selects a therapy mode, fill mode,
and an ordering physician. Selection of modes at this point
establishes defaults limits for subsequent steps. As a result, work
flow inconvenience may be eliminated when the user defines the fill
mode changes. As a result, previously entered data may be reset to
the machine default for the new fill mode. The user may then be
required to return to the first tab and start over. FIGS. 27-35
illustrate the steps that the system 1 and the method 100 of the
present invention implement to prompt a user to effect the
prescription fill and recording of the prescription within the
system 1 and method 100 of the present invention.
[0217] As will be further described, the system 1 and the method
100 of the present invention enables a user to digitally assign a
patient's prescription and supply chain components and/or send to
the supply chain website or otherwise received at the supply chain.
As a result, a physician's digital certificate acting as an actual
signature is provided for the prescription. To this end, an
interface may be provided between the system 1 of the present
invention and various supply chain systems to effect home patient
ordering and delivering of prescriptions. Each system may include a
variety of applications and/or interfaces. First, country specific
rules may be provided in an application to enter and maintain rules
specific to each country at which a supply chain may be used to
effect completion and/or delivery of a prescription. Data
maintained in the application may include a country identifier,
whether a prescription is required for an order to be generated,
whether a digital signature is required on a prescription, a level
at which a digital signature may be required, and whether a
physician identification exists.
[0218] Another application may include unit registration and may
allow a dialysis center or a supply chain to register and maintain
information unique to their business. To this end, a web-based
front end may be provided to register and manage unit specific
data. Data entry may be used for initial sign-up to the supply
chain. The front end may also prompt the user to set up the
information and download a list of patients associated with the
unit. An interface may be provided through the supply chain systems
to retrieve a list of valid entities associated with the system.
Further, an interface with the supply chain systems may be provided
to retrieve a list of positions associated with the center. In
addition, an interface with the supply chain systems to retrieve a
list of patients associated with the center may also be provided
with the unit registration application.
[0219] A patient enrollment interface may be provided that allows
for the automated initiation of new patient enrollment subsequent
to update of the supply chain systems. A patient enrollment
interface may include updating supply chain address book
information regarding patient enrollment. A module may add new
patient name and address information to the supply chain database.
Further, the patient enrollment interface may include update supply
chain patient activity information that may add information to the
supply chain database that may be necessary to complete a
transaction. In addition, the patient enrollment interface may
update supply chain patient demographic information available at
the time of enrollment and maintained in the supply chain system.
Further, initial supply chain prescriptions may be created within a
supply chain system. Initial orders may be generated and
acknowledged using predefined distribution methods and recipient
lists that acknowledge that the order was created.
[0220] A product prescription management interface may also be
provided. The automated processing of updates to patient's product
prescriptions in the supply chain system may be performed from
initiated events. An inventory management and replenishment order
generation interface may be provided for the automated updating of
patient inventory in the supply chain system from transactions
previously initiated or from, for example, an external hand-held
device. A replenishment order and order acknowledgment may be
automatically triggered, at least upon defined inventory
levels.
[0221] Still further, a patient management interface may be
provided to update patient information in the supply chain system
from previous transactions. Patient address book information,
patient gain/loss information and patient demographic information
may be updated and the interface may be built upon the patient
enrollment interface. Synchronization between the supply chain and
previous systems may be ongoing and allow changes initiated in the
supply chain system to be communicated. The interfaces, patient
name and address changes, mode of treatment changes, patient and
activation and product prescription changes may also be
provided.
[0222] The system of the present invention may download formatted
transactions to a transmission layer for eventual processing in a
system at the supply chain. Formatted transactions may be imported
from the transmission layer for updating of the database. The
transmission layer may facilitate processing of transactions
between the supply chain system. An application server and
associated code for the web application is built as a front end to
the transmission layer. A database facilitates the storage of data
as the data is passed through the transmission layer. Procedures
may be stored and/or activated to initialize, extract, format and
transmit data in and out of the transmission layer. A standardized
method for formatting data passed to and from the transmission
layer may be provided, i.e. SNTP, ASCII, or the like.
[0223] The supply chain system provides back-end processes to
receive and send data to and from the transmission layer. In the
supply chain system, file formats may be used in the transmission
of data back and forth to the transmission layer; to schedule jobs
that may invoke programs that store procedures to receive data from
the transmission layer; to apply supply chain business rules and
update supply chain databases provided; and to schedule jobs that
may invoke programs and stored procedures to extract data
transactions from the supply chain databases and send them to the
transmission layer.
[0224] FIG. 36 generally illustrates the supply chain integration
between the system 1 via the internet to the point at which
supplies are provided and/or sent for delivery. To this end, the
system 1 includes clinical data entry 202 to the system 1 of the
present invention via the internet or directly to the supply chain
23 to provide information necessary to effect order delivery, as
shown at 204. To enroll a patient to the supply chain, such as a
home hemodialysis patient, a healthcare professional, a doctor, or
the like enters patient treatment information into the system 1 as
well as patient and demographic information. Further, a prescribing
physician is assigned to the account including "bill to"
information. The patient prescription is input which may include
capture of an electronic signature. A patient account number may
then be assigned, and information regarding the patient may be
recorded including the prescription information, or the demographic
information of the patient. Then, the patient initial order may be
generated. The supply chain patient enrollment and prescription
transaction may then be submitted to the supply chain via the
Internet or via infrastructure supported at the location of the
supply chain.
[0225] FIGS. 37 and 38 generally illustrate user requirement
specifications for effecting delivery of prescription and
prescription information via a supply chain.
[0226] FIGS. 39 to 49 generally illustrate the program architecture
for the system 1 and method 100 of the present invention. The
architecture shown and described with reference to FIGS. 39 to 49
shows a process from which Chronic Kidney Disease (CKD) patient may
be evaluated by a multi-disciplinary team providing care to the
patient.
[0227] To this end, as illustrated in FIG. 39, a program may be
initialized at step 300 to allow the team at a renal facility to be
entered to identify the individuals who may provide care to the
patient. Individuals become part of a selected care team as
identified at step 302. At that time, a clinical encounter, as
shown at step 304, follows patient assignment to a physician. The
clinical encounter includes the input of patient information as
shown at step 306, the input of medical information as shown at
308, a physical assessment as shown at step 310, and a diagnostic
assessment as shown at step 312. The input medical information may
include a renal clinical history as shown at step 314, a non-renal
clinical history as shown at step 316, and a medication history as
shown at step 318. In addition to the non-renal history, that
information may be further subdivided into medical surgical history
as shown at step 320, family/social history as shown in step 322,
and a system review as shown at step 324.
[0228] Monitoring of care pathways occurs as shown in FIG. 40 at
step 400. Monitoring of care pathways takes pertinent aspects of
clinical care of a renal patient into consideration. Each aspect
may be reviewed and the needs and/or care of the patients as
pertaining to a particular disease state, i.e. anemia, mineral
metabolism, and the like may be evaluated. Data may be imported
from other areas in the system that apply specifically to the
problem addressed. For example, to evaluate anemia, lab values
and/or medications which pertain to the doctor or physician or
other healthcare decision relating to anemia are imported to a
screen directed to anemia. Aspects of patient education may also be
included to enhance delivery of education and patient choices as a
result of the education.
[0229] FIGS. 41 to 49 illustrate the specific tracking that occurs
through the clinical and care pathways for the dialysis patient.
Each of the clinical and care pathways and their respective program
descriptions as generally illustrated in FIGS. 41 to 49 will be
more clearly described with reference to the subsequent description
regarding each of the pathways.
[0230] The system 1 and the method 100 of the present invention may
also create a "to-do list" indicative of any areas have not been
completed. The "to-do list" at a center may be created which may
identify a patient or patients that may not have received one or
more aspects of care at a particular level or levels of renal
function. For example, a list of patients who have reached stage 4
of renal failure and who have not been educated on dialysis and
transplanting options may be generated on a "to-do list". FIG. 50
generally illustrates a screen that pops up as a reminder regarding
specific items that must be completed in a "to-do list" format.
[0231] An encounter summary screen may also be provided as a
summary of medical history and current assessment and data on a
patient on a particular date. The encounter summary represents a
"snap shot" of a visit of the patient with a particular doctor or
medical professional on a specific date and time. The encounter
summary may include categories of information relating to renal
disease history, medications, allergies and physical assessment.
These categories of information may be entered in subsequent pages
and may then be printed on the encounter summary page as a summary.
The information is historical in nature and may be saved for each
visit of each patient. In addition, while previous dates may be
chosen in the field after a selection, a summary for the date may
be shown. The remaining figures should be considered in conjunction
with the architecture shown and described with reference to FIGS.
41 through 49.
[0232] A renal disease pathway screen is shown which provides a
summary for imported information including renal diagnosis,
performed biopsy, lab values and medications pertinent to renal
disease treatment or prevention or that which delays the
progression of renal disease. The renal disease pathway brings the
renal disease related information to a single screen which a
physician may review to treat or otherwise evaluate renal disease.
The medication list may be viewed by selecting medications on tabs
available with the screen. A hyperlink may be provided to link to
published guideline sites for treatment of renal disease which may
be obtained by selecting the guidelines prompt. The information
provided on the clinical pathway for renal disease may include
information imported from other parts of the system collected that
may be appropriate for the renal disease clinical pathways page.
The lab information may be input into the system through a lab
interface as previously described and grouped according to the
appropriate pathways, such as the renal pathway. The medications
associated with the clinical pathway for renal disease may display
a medications window and may provide access to the functionality
set forth to describe the medications/allergies tabs for a clinical
encounter. A guidelines button launches a pop-up dialogue with
guidelines for this pathway and links to specified guideline
documents. Further, tabs may be provided for renal disease, anemia,
diabetes mellitus, mineral metabolism, hypertension, lipid
disorders, nutrition and preventative. CKD stage calculations are
provided with stage 1 for GFR.gtoreq.90 wherein the GFR
calculations are provided in the renal disease tab. Stage 2 is
calculated with 60.ltoreq.GFR<90; stage 3 has 30<GFR or
<60; stage 4 has 15.ltoreq.GFR or <30; stage 5 has GFR<15.
Calculated fields are present on the-renal pathways window, such
as, serum chemistries which may display an ion gap, corrected
calcium or creatinine clearance. The system 1 and the method 100 of
the present invention verify that all units are using the same
measure, or the units are converted. Preferably, the nature of the
renal disease may be displayed as information from the most recent
clinical encounter, and any information from the previous encounter
is automatically re-worded to the current encounter.
[0233] Referring now to FIG. 53, the diabetes mellitus pathway is
generally shown with the screen illustrated in FIG. 53. The pathway
is a page of imported information and/or manually entered
information pertaining to diagnosis and treatment of diabetes
mellitus (DM). The imported information may include lab values and
medications used to diagnose or treat DM. Manually entered
information may be provided to assist with information related to
the prescription of DM treatment. In addition, information
regarding the patient in treatment, such as glucose monitoring,
exercise, diet and other DM related issues including foot care may
be provided. The same functionality exists with the tabs in the
screen of FIG. 53 as that described with respect to the renal
disease clinical pathway in FIG. 52.
[0234] Referring now to FIG. 54, a mineral metabolism pathway is
generally illustrated which includes a screen of imported
information pertaining to the diagnosis and/or treatment of bone
disease in a renal patient. Lab imports include calcium,
phosphorus, parathyroid levels which must be maintained to decrease
bone disease progression. Medication lists may be viewed in a
side-by-side profile to view effectiveness of the treatment. The
medication lists may be viewed as well as guidelines and/or sites
pertaining to the treatment of bone disease in renal patients.
[0235] Referring now to FIG. 55, care pathways for education
tracking are generally illustrated wherein the doctor or other user
or medical professional may track delivery of education by time
spent and/or type of session. In addition, parameters relating to
the location, participants present, an individual versus group,
type of educational materials dispensed, as well as family members
and/or partner present may also be input. The screen further
provides for tracking of pre-learning and post-learning assessment
as a result of the training or education. The navigation link
includes a print button that opens a pop-up dialogue allowing a
user to select materials for printing. Under the materials
discussed, items in each list are selected, a components list may
populate with subordinate components and are shown as selected. The
user may de-select individual components. Selecting a package
removes the subordinate components from the list. Preferably, the
grid is sorted in descending date order.
[0236] Referring to FIG. 56, a care pathway for educational
assessment may be provided that provides information that allows an
educator to tailor education towards the grade level of the
patient, interests, disease stage, and/or physical deficiencies.
The learning methods for the patients may be identified with free
text fields within the educational assessment screen that allow the
user to identify hobbies, interests and social or religious factors
which may impact the education delivery. A number of tabs and/or
sub-tabs may be provided in the screen including educational
assessment, CKD education, modality planning including eligibility
evaluation and modality choice, access planning, dialysis
initiation and/or transplant workup. Personnel within a clinic may
be restricted to various pathway tabs based on their role within
the clinic.
[0237] Referring to FIGS. 57(a) and 57(b), a care pathway for
modality eligibility and/or planning may be provided via the screen
shown in FIGS. 57(a) and 57(b). With respect to FIG. 57(a), the
modality eligibility screen allows a clinician or educator to
document whether the patient may be eligible for peritoneal
dialysis (PD), hemodialysis (HD), or transplantation (T) from a
medical and/or psycho-social perspective. Any particular category
may be checked "no", and one or more reasons for eligibility may be
prompted by the modality eligibility screen. The information allows
the user to monitor patients who may be eligible for therapies who
may not be receiving them and/or identifying an issue leaving the
particular patients ineligible for various therapies. FIG. 57(b)
illustrates the modality choice following the eligibility
evaluation conducted with respect to FIG. 57(a).
[0238] FIGS. 58(a) and 58(b) relate to modality choice including
discordant reasons. The screens illustrated in FIGS. 58(a) and
58(b) regard modality choice which indicate the care giver's
opinion or opinions for which therapy should be chosen for the
patient based on eligibility criteria or patient discussion. A
patient, a nurse, a doctor, or other health care professional has
made a choice, and the choice is noted. If the patient and health
care choice is discrepant, the reason may be noted. Information may
then reveal that the patient or medical professional has a bias or
differing choice than the reason, or its occurrence may require
determination.
[0239] Referring to FIG. 59, an access planning screen may be
provided to note the type of dialysis access chosen to be placed. A
reference date to the surgeon, when the access is placed, and a
follow-up appointment made, may be information provided on the
screen. The access planning screen encourages monitoring of the
patient for access placement and follows access placement. The text
field notes results of patient placement following surgical access
placement.
[0240] Referring now to FIGS. 60(a) and 60(b), dialysis initiation
screens may be provided to track the type of dialysis access being
placed and/or whether the access is a permanent type or temporary
type. Preferably, access is placed soon enough to heal (permanent
access) and tracking of where the access is placed (inpatient
versus outpatient) and a place within the hospital where the
patient was admitted. FIG. 60(a) relates to modality initiation
within the care pathway, and FIG. 60(b) relates to transplant
workup. Within the modality initiation, the sub-type depends on the
modality type selected. Temporary and permanent access lists under
the access used section depends on modality type. Further, a
bridge-only panel is disabled if chronic is selected; and the
hospital only panel is disabled if outpatient is selected. The
final dialysis modality choice may be pre-populated based on the
final choice made on the modality planning form. The user may be
prompted if they attempt to change tabs without saving changes.
Referring to FIG. 60(b), a transplant workup may be identified as
complete after a submitted referral has been checked and the date
entered. On cadaver wait list may be entered or LRD workup may be
checked and date entered; or all initial workup fields checked and
dates entered.
[0241] Referring now to FIGS. 61(a)-61(f), charts are illustrated
defining various care pathway assignments based on various
laboratory results. Laboratory results may then be fed into the
pathway as identified in the charts shown in FIGS. 61(a)-61(f)
automatically.
[0242] FIG. 62 illustrates a clinical pathway relating to
preventative measures, for example, vaccinations and screenings. A
date may be entered relating to each vaccination received, and
screening dates may be entered for the next scheduled or necessary
date to obtain a particular screening.
[0243] A nutrition pathway is illustrated in FIG. 63 which may
include information based on past, current or future nutritional
requirements.
[0244] FIG. 64 illustrates a clinical pathway screen for lipid
disorders including values for total cholesterol, HDL, LDL,
triglycerides and/or LDL/HDL ratio. Imported information may be
provided from the medications as previously discussed.
[0245] Referring to FIG. 65, a hypertension pathway may be provided
which includes text information with respect to any condition
related to hypertension as well as any imported or other
information regarding medications.
[0246] Referring now to FIG. 66, the anemia pathway is imported
information from other areas of the software which may be pertinent
to the diagnosis and/or treatment of anemia. Information may
include lab values such as hematology and iron studies and
medications used in the treatment of anemia in renal disease
patients. Prescription of medications may be identified by clicking
on medications. The guidelines pertinent to the treatment of anemia
may also be seen as an appropriate website by clicking
"guidelines." The format of the screen encourages medical
professionals to view all aspects of anemia that impact treatment
and/or effectiveness of the treatment, such as low iron levels that
may decrease effectiveness of erythroeocitic medication. Otherwise,
the doctor may review whether blood levels are low while the
erythroeocities which may be due to low iron. Various calculated
fields may be provided, such as, for example, transferrin
saturation, calculated transferrin and calculated TIBC. All units
may be converted and preferably conventionally input as required to
perform the calculations.
[0247] FIGS. 67-83 illustrate a renal peritoneal dialysis (PD) and
hemodialysis (HD) access management system. The PD and HD access
management system is a comprehensive tool to track PD and HD access
information. As used hereinafter, "access" may refer to access
placement, infections and non-infection related problems associated
with PD and/or HD, medications associated with PD and/or HD, and
hospitalizations associated with PD and/or HD.
[0248] Referring now to FIG. 67, an access summary report screen is
generally illustrated. The access summary report screen may be
displayed on a computer to be viewed by a patient, a physician
and/or a user. An access report may be provided on the access
summary report screen and may provide an overview of the patient
care relating to access treatment. A summary report may be provided
on the access summary report screen beneath the access report and
may display data about the access of a patient. The report summary
may contain relevant data, such as, for example, implant date,
surgeon and/or treatment facility. The information may be presented
in a reverse chronological order to compare infection problems and
non-infection problems in a manner to simplify comparison of the
infection problems and the non-infection problems.
[0249] Referring now to FIG. 68, a treatment history screen is
generally illustrated. A treatment history report may be provided
on the treatment history screen and may provide a collection of
information from a history of a patient. The treatment history
report may include, for example, a collection of medications,
hospitalizations and/or interventions performed for any problems
associated with the access. The treatment history report may
provide a description of the access followed by a section for
infection problems and a section for the non-infection problems.
Data for the infection problems and non-infection problems may be
displayed, including the dates, treatment and/or treatment
locations associated with the treatment of the patient. Medications
assigned for either an infection problem or a non-infection problem
may be displayed on the screen including, for example, duration,
dosage, route and/or frequency of the medication.
[0250] Further, the treatment history report may display
hospitalization information associated with the infection problems
and/or the non-infection problems. The hospitalization information
may include an admit date and/or a discharge date as well as a
final diagnosis for the patient. Interventions, treatments and/or
outcomes of the interventions for the patient receiving treatment
may also be illustrated on the treatment history screen. The
interventions, treatments and/or outcomes of the interventions may
be displayed in reverse chronological order to display a time line
of treatments associated with the access of the patient and/or a
complication with the access.
[0251] FIG. 69 illustrates a hospitalization summary report screen
as displayed on a computer. The hospitalization summary report
screen may contain and/or may display a description and/or
information related to hospital admissions associated with an
access and/or a problem associated with the access. The
hospitalization summary report screen may display hospitalization
data displayed and may have sections displaying infection problems
and/or non-infection problems that may require hospitalization.
[0252] Referring now to FIGS. 70-78, an access tab screen may be
displayed on a computer containing data pertaining to the access of
the patient. The access tab screen may be divided into three
subtabs including implant details, clinical assessment and/or
dynamic assessment. The access tab screen may be provided to track
and/or to manage the history of treatment for the patient. The
access tab display screen may display access implantation and/or
removal/abandonment for the patient.
[0253] FIG. 70 illustrates an implant detail screen. The implant
detail screen may contain data relating to access implantation for
the patient. Implantation data, such as, for example, implantation
date, physician and/or implantation facility type may be collected
for a single access and/or for a plurality of accesses of the
patient. PD specific data such as, for example, break in method
(for inserting an access) and/or first full prescription date may
be collected and/or displayed on the implant detail screen. HD
specific data, such as, for example, access location and/or first
use date, may be collected based on the modality of the access. The
implant detail screen may display subsequent access removal and/or
abandonment data of the patient.
[0254] FIG. 71 illustrates a clinical assessment screen displayed
on a computer which may provide information on care of the patient.
Subsequent to implant data entered into the system, clinical
assessments for the implant data may be entered for an access of
the patient. Data collected as part of the clinical assessment may
vary depending on the type of access/patient modality. Clinical
assessments may be displayed in reverse chronological order so the
most recent assessment may be visible when the access tab is
selected. The assessment screen for a patient undergoing HD, for
example, may collect data on the time of assessment of the patient
including pre-treatment, post-treatment or no treatment data.
Additionally, a physician and/or user may enter clinical assessment
data directly into the clinical assessment screen. FIG. 72 further
illustrates a clinical assessment screen that may contain a PD
assessment area. The screen may illustrate, for example, that a
culture was taken as part of the clinical assessment process.
[0255] Referring now to FIG. 73, a dynamic assessment screen is
illustrated. The dynamic assessment tab may contain collected data
on an outside assessment performed with regard to the patient.
Measurements for dynamic venous pressure and/or arterial pressure
may be displayed on the dynamic assessment screen to assist the
user with measuring the tendencies of the data. A user may enter
pre-pump and post-pump arterial pressure. The screen may allow a
user to calculate the re-circulation percentage for the patient
based on BUN values and/or a user may enter a re-circulation
percentage directly into the field or may enter all required BUN
values. Blood urea nitrogen (BUN) is a measure of the amount of
urea nitrogen, a waste product of protein metabolism, in the blood.
Urea is formed by the liver and carried by the blood to the kidneys
for excretion. Because urea may be cleared from the bloodstream by
the kidneys, a test for measuring an amount of urea nitrogen that
remains in the blood may be used as a test of renal function. If
the required BUN values are entered, a calculator associated with
the dynamic assessment screen may display a re-circulation
percentage for the input values. The formula for calculating
re-circulation may be: 1 100 [ BUN ( systemic ) - BUN ( pre ) ] [
BUN ( systemic ) - BUN ( post ) ]
[0256] If the re-circulation percentage is entered manually,
changes to the BUN values may not be re-calculated. The
re-circulation percentage may be saved to a database.
[0257] Referring now to FIG. 74, a secondary dynamic assessments
screen is illustrated. The secondary tab may display collected data
on radiology studies with regard to the access of the patient. The
tab may also display BUN flow rates for APD patients that may be
collected by a home BUN detection device. Flow rates may be viewed
periodically, such as monthly, or by a specific date. The tab may
also display flow rates including inflow and drain information.
[0258] Referring now to FIG. 75, an infection tab screen as
displayed on a computer is illustrated. The infection tab screen
may provide infection information for an access of the patient. The
screen may display collected data on an infection associated with
the access of the patient. Infection data may be displayed in
reverse chronological order, and the most recent infection may be
viewed first. The infection tab screen may display infection
information based on, for example, whether the access is for a PD
patient and/or an HD patient. Access infection culture and/or
laboratory data may also be entered by a physician and/or a user on
the infection tab screen. Further, the infection tab screen may
display the active treatment for the patient undergoing PD or HD.
The medication screen may be opened from the infection tab by a
user by clicking on an Open PD Rx button on the infection tab
screen. After the medication screen is open, a new PD prescription
and/or a new HD prescription may be entered for the patient.
[0259] Referring now to FIG. 76, a non-infection tab screen is
illustrated. The screen may display collected data on non-infection
problems associated with the access of the patient. The
non-infection problems associated with the access of the patient
may be displayed on the screen in reverse chronological order. For
example, the most recent non-infection access problem may be shown
first. If non-infection data is saved in the system, medication
prescription data associated with the non-infection problem may be
displayed.
[0260] FIG. 77 illustrates a medication tab. The medication tab in
the access window may allow a physician and/or a user to enter
prescription data for medications that may be used to treat access
infection problems and non-infection problems. The medication tab
may display an association between the medication and the infection
problems and/or the non-infection problems. Previously associated
infection problems and/or non-infection problems may be displayed
on the medication tab. A user may enter new prescription
information into the medication tab. If a user returns to the
infection or non-infection tab, the screens associated with the
infection problems and/or the non-infection problems may display
the new medications associated with the current infection.
[0261] Referring now to FIG. 78, a hospitalization tab is
illustrated allowing a user to enter and/or obtain hospital
admission data for infection problems and non-infection problems
relating to the care of the patient. The hospital tab may include
hospitalization information, such as, for example, admission date,
hospital location, physician, diagnosis, discharge date and/or
discharge notes. The hospitalization tab may also identify the
infection problems and/or the non-infection problems for the
patient.
[0262] Referring to FIGS. 79-83, various screens relating to
Chronic Kidney Disease (CKD) access planning are shown. FIG. 79
illustrates a CKD access planning screen which may be used to track
and/or to manage the treatment of the patient. The CKD access
planning screen may allow a user to input information to facilitate
the planning of dialysis care for the patient. The planning screen
may include, for example, access detail, access type, assessment
dates, implantation details and the type of modality to be used in
the treatment of the patient. Referring to FIG. 80, a screen
associated with hemodialysis (HD) prescription may be provided. The
HD prescription screen may provide information relating to the most
recent access for a patient. The HD prescription screen may
display, for example, medications prescribed to treat an infection
problem and/or a non-infection problem, prescribing physician,
medical devices used, and laboratory schedules for the patient.
[0263] FIG. 81 illustrates a hemodialysis treatment window. The HD
treatment window may provide information relating to the treatment
of an infection problem or a non-infection problem of the patient.
The window may display, for example, treatment for a patient
access, laboratory studies, dialyzer reuse, fluid work sheets,
vital signs, physician and/or user observations, medications and a
final sign off by the physician and/or user relating to the care of
the patient undergoing hemodialysis.
[0264] Referring now to FIG. 82, a PD prescription screen is
illustrated. The PD prescription screen may display, for example,
treatment progression, medications and reports on the treatment of
the patient. A user may view a single PD access site or multiple PD
access sites. The data may be stored in a table which may associate
the medication to the access. The access may be modified at any
time without impacting the prescription.
[0265] FIG. 83 illustrates a screen displaying PD compliance.
Compliance factors for each date in a selected date range may be
queried by a physician and/or user. The alert may be displayed on
the screen if the compliance item is out of range.
[0266] It should be understood that various changes and
modifications to the presently preferred embodiments described
herein will be apparent to those skilled in the art. Such changes
and modifications may be made without departing from the spirit and
scope of the present invention and without diminishing its
attendant advantages. It is, therefore, intended that such changes
and modifications be covered by the appended claims.
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